Sulfonylureas and Meglitinides

Who?

Sulfonylureas and meglitinides are recommended for persons with type 2 diabetes who have poorly controlled blood glucose levels. On average, most patients find that their Hb A1c levels drop by up to 1.5% on these medications.

What?

Oral tablets – sulfonylureas stimulate the pancreas to release insulin over a period of several hours. Common brands include:

Meglitinides stimulate a shorter term burst of insulin to cover mealtimes. Common brands include:

Where?

Sulfonylureas and meglitinides work by stimulating the pancreas to release insulin.

When?

Sulfonylureas are usually taken once or twice a day, in the morning and/or evening, depending on the brand:

Chlorpropramide is taken once a day (typical daily dose: 100 mg to 500 mg)
Glipizide is taken once or twice a day (typical daily dose: 5 mg to 40 mg)
Glyburide is taken once or twice a day (typical daily dose: 1.25 mg to 20 mg)
Glimepiride is taken once a day (typical dose: 1 mg to 4 mg; maximum 8 mg daily)

Meglitinides are usually taken 15-30 minutes before each meal:

Repaglinide is taken at doses ranging usally from 0.5 mg to 4 mg with each meal
Nateglinide is taken at doses ranging usually from 60 mg to 120 mg

Why?

Sulfonylureas are very effective at controlling blood glucose and can lower A1C levels.
Sulfonylureas can cause low blood glucose, or hypoglycemia, if the patient skips a meal. This tends to occur in patients who are older or have kidney disease.
Patients with worsening kidney function may need to reduce their dose or stop these medications to avoid hypoglycemia
Patients tend to gain a few pounds of weight on these medications